Cannabis might relieve symptoms in some with IBD

Last Updated: 2018-11-21

By Will Boggs MD

NEW YORK (Reuters Health) - Cannabis might provide symptomatic relief for some patients with inflammatory bowel disease (IBD), but there is no evidence showing a beneficial effect on the disease itself, according to a new review.

"Because IBD treatment is so complex and even our best therapies (alone or in combination) may not be enough to get every patient into remission, we have to keep an open mind toward strategies that can help our patients feel better by controlling symptoms," Dr. Arun Swaminath of the University of Chicago Medicine Inflammatory Bowel Disease Center told Reuters Health by email.

Dr. Swaminath and colleagues summarize the preclinical data, clinical data, safety data and the regulatory landscape as they apply to medical cannabis use in IBD in a white paper online October 24 in Inflammatory Bowel Diseases.

While there are many proponents of cannabis use to relieve IBD symptoms and improve appetite, and upwards of 12% of IBD patients report active cannabis use, there has been no controlled prospective evaluation of cannabis in the management of IBD in the U.S.

Based on studies elsewhere, limited evidence suggests that cannabis use may offer symptomatic benefit and improved quality of life when patients have poor or incomplete response to standard therapy.

None of the data, however, demonstrate improvement in biochemical or disease activity scores associated with cannabis use in patients with IBD.

What's more, the long-term safety of chronic cannabis use has yet to be defined, especially in IBD patients.

In adolescents, emerging literature suggests that cannabis has significant adverse health effects on neurologic, cognitive and mental health. The American Academy of Pediatrics and the Academy of Child and Adolescent Psychiatry oppose cannabis legalization.

The effects of cannabis in pregnant and lactating women are even less clear. The American College of Obstetricians and Gynecologists does not recommend or endorse the use of cannabis in pregnant patients because of observational data linking its use to low birth weight and preterm delivery.

As of January 2018, medical cannabis is legal in 30 states plus the District of Columbia, and nine of these states and the District of Columbia have legalized recreational cannabis for adults over 21 years of age. But the possession or sale of cannabis remains illegal under federal law, and its classification as a Schedule I drug significantly complicates further research.

Dr. Swaminath offers several suggestions to physicians: "First, ask your patients if they're already using cannabis and if they're using it to control any specific IBD symptom. It's very important that this needs to be done in a nonjudgmental fashion."

"Second, see if the patient has achieved deep remission (meaning that at least the mucosa has healed back to normal appearance on colonoscopic evaluation)," he said. "If not, then the goal would be to intensify or change the current therapy to achieve that endpoint and see if any symptoms still persist."

"Finally, there are patients who have been tried on various IBD treatments with partial benefit, and adjusting or changing treatments may not be feasible," he said. "In that case, symptom-based therapy (i.e., diarrhea, pain, appetite) with cannabis products may benefit the patient."

Dr. Swaminath added, "Natural is not the same as safe. Cannabis consumption can affect motor coordination (motor vehicle accidents) and approximately 9% of adult users become dependent (higher if used in adolescents). There are a large number of drugs (and even diet studies!) currently in investigation, so if a patient has not found benefit from currently available therapies, seeking access to and participating in clinical trials will be crucial."

Dr. Ann Marie Kerlin, associate professor of biblical counseling at Luther Rice College and Seminary, in Lithonia, Georgia, recently evaluated profiles of IBD patients who use marijuana. She told Reuters Health by email, "IBD has no known cure, so patient interest in new treatments is always high. Right now, while many patients claim perceived benefits anecdotally, there has not been sufficient research to definitively state that a particular type or amount of cannabis helps IBD patients with a particular symptom."

"IBD patients should be cautious when interpreting claims of its benefits; I hope to see some clinical trials of cannabis or its derivatives for IBD patients conducted in the near future," she said. "This article points to the need for research to answer questions that both patients and their doctors may have about cannabis and its use."

SOURCE: https://bit.ly/2QX5ZF7

Inflamm Bowel Dis 2018.